Provider Demographics
NPI:1659531382
Name:BALYOZIAN, CHARLES JOHN
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOHN
Last Name:BALYOZIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SCITUATE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6208
Mailing Address - Country:US
Mailing Address - Phone:781-863-8282
Mailing Address - Fax:781-863-8811
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-863-8282
Practice Address - Fax:781-863-8811
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist